Avoid injuries on the mat with this practical guide to caring for your knees, hamstrings, and sacrum ~ by Roger Cole
If you practice yoga,
no doubt you're aware of its health benefits. But like any physical
activity, it's not completely risk free. If you've been practicing
for long, you or someone you know has probably pulled a hamstring,
tweaked a sacrum, or experienced some injury while on the mat. Close to
9,000 Americans
received medical treatment for yoga-related injuries in 2004 and 2005,
according to the U.S. Consumer Product Safety Commission. Still, there
are only two
yoga injuries reported for every 10,000 times it is practiced, according
to American Sports Data.
Injuries can be great teachers. They invite you to uncover your yoga
demons—misalignments or overzealous attempts to force your way into
poses—and make
corrections. But it's smart to learn proper technique, especially when
it comes to your inner knees, hamstring tendons, and sacroiliac joints.
These parts
are vulnerable to damage and take time to mend. But if you understand
what causes trauma to these areas, it's easy to adjust your practice to
avoid or help heal injuries.
Inner Knee
The Road to Injury
Have you always found it difficult to get into
Padmasana
(Lotus Pose) and felt tempted to force your legs into the position to
join your serene-looking
classmates for meditation? If you are thinking of traveling down this
road, please reconsider. You may have discovered that rather than
leading you to the
blissful land of the Lotus, pushing yourself in this way dead-ends with a
sickening "pop" in the knee, followed by years of pain and limited
mobility.
When you hurt your inner knee doing yoga, it's usually because you've
tried to force a leg into Padmasana or one of its variations. Sometimes
the injury occurs after one or both legs are already in Lotus position
and you attempt a pose that adds a back-bending movement, such as
Matsyasana (Fish Pose), or a
forward-bending movement, such as Ardha Baddha Padma Paschimottanasana (Half-Bound Lotus Seated Forward Bend).
To understand how Lotus can hurt your knee, visualize lifting your right
foot up and placing it atop your left thigh. To get into this pose
safely, your thigh will have to rotate outward about 115 degrees. For
many of us, though, the thigh cannot turn out that much, either because
of its bone structure or because tight muscles and ligaments inhibit its
movement. If your thigh stops rotating but you keep lifting the shin
and foot, you'll bend the knee joint
sideways, which will pinch the inner-knee bones together—the upper inner
end of the shin-bone pressing against the lower inner end of the
thighbone.
Between these bones lies the medial meniscus, which is a protective rim
of cartilage that pads the knee joint and guides its movement. When you
lift your foot, you are using your same-side shinbone as a long lever.
If the thighbone doesn't rotate enough, you'll apply tremendous pinching
pressure to the meniscus—as if your shinbone and thighbone were a giant
pair of pliers. Forcing this lift even moderately can do serious
damage. Similarly, if you are in Lotus and your top knee is not on the
floor, pushing that knee downward can apply enormous damaging force to
the meniscus.
Prevent and Prepare
To prevent this injury, the first rule is to never force your legs into
any Lotus variations—either by pulling the foot strongly upward, pushing
the knee
downward, or thrusting your body forward or backward. Don't let your
yoga teacher push or pull you into any of these poses either.
Janu Sirsasana
(Head-of-the-Knee Pose) and
Baddha Konasana
(Bound Angle Pose) can cause similar (though usually less severe)
pinching of the inner knee, so practice them cautiously, too. Stop going
deeper and back off if you feel pressure or pain in the knee. The
structures that need to loosen up in these poses are all located around
the hip area, so that's where you should feel stretching or releasing
sensations as you go deeper.
The safest way to practice Padmasana and related poses is to strongly
rotate your thigh outward at the hip and not go deeper into the pose
when you reach the limit of your outward rotation. This means that
you'll have to stop lifting your foot when your thigh stops rotating, so
you may not get your foot on the opposite thigh. (Remember the upside:
happy, functional, pain-free knees.) You can use your hands or a strap
to help rotate your thighbone outward. Whether using your hands, a
strap, or a cloth, if your knee ends up dangling in midair, support it
with a folded blanket so you do not inadvertently force it downward as
you turn the thigh outward.
The Path to Healing
If you have the misfortune of hurting your inner knee in Padmasana or a
related pose, the first thing to do is leave it alone. You need to rest,
ice,
elevate, and compress it for a few days to reduce swelling and
inflammation. If the injury seems serious, seek medical attention. It's a
good idea to
reintroduce knee range of motion as early as you can by gently flexing
and extending the knee to the extent possible. A yoga program for
recovery needs to
be individualized to your needs and supervised by a qualified
instructor. But the general pattern is to promote alignment and strength
with basic standing
poses, such as
Trikonasana (Triangle Pose) and
Virabhadrasana II (Warrior Pose II). If necessary, support your body with a chair to take weight off the
knee. In addition, increase range of motion by doing
Virasana
(Hero Pose) with the pelvis supported on a prop, and eventually
reintroduce outward rotating movements like Baddha Konasana (and perhaps
Padmasana) using a rolled cloth behind the inner knee.
Padmasana (Lotus Pose), preparation
Set up blankets to support your pelvis and right knee. Sit in Dandasana
(Staff Pose) with both legs extended. Bend one knee and place a
washcloth behind
it. Keeping the knee firmly bent, grip the end of the cloth in one hand
and pull toward your body and out to the side to open the inner knee and
rotate the
thighbone outward. Continue this rotation as you lift your heel with
your other hand and place your foot high atop the opposite thigh, near
the hip if
possible. Note: Discontinue if you experience knee discomfort.
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Virasana (Hero Pose), modification
Avoid pain in your knees by elevating your pelvis as high as is
necessary with folded blankets. Align your heels directly under your
outer hips (this is
less stressful for the knees than the standard alignment of having your
heels outside of your hips). Keep your knees slightly apart, with your
thighbones
parallel. Place your feet in line with your shins. Sit for several
minutes daily. Gradually lower the props over a period of weeks or
months.
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Roger Cole, PhD, has practiced yoga since 1975 and taught since 1980. He
is a certified Iyengar Yoga teacher trained at the Iyengar Yoga
Institutes in San Francisco and Pune, India. He teaches at Yoga Del Mar
in Del Mar, California. For more information, visit http://www.rogercoleyoga.com.